The Follow-up Research After Mitral Valve Replacement Of Rheumatic Heart Disease With Mild Aortic Insufficiency

Objective:Through the follow-up research of the patients with rheumatic heart disease underwent mitral valve insufficiency with mild aortic regurgitation, to discuss whether this kind of patients with rheumatic heart disease need preventive treatment at the same time of mitral valve replacement, and to analysis the progress situation of mild aortic valve insufficiency, and to guide the clinical surgical indications.Methods:Collection data about patients who underwent mitral valve replacement between December 1999 and December 2014 incardiovascular surgeryof Guizhou Province People's Hospital, their preoperative diagnosis of aortic valve is mild, and without the surgical treatment, and the data was included in retrospective study(a total of 250 patients).The basic condition of clinical evaluation of mild aortic valve :1. The preoperative diagnosis for patients were with rheumatic heart disease, need mitral valve replacement;2. Patients without aortic insufficiency related symptoms: angina pectoris, faint and syncope;3. The echocardiographic in Guizhou Province People's Hospital hints mild aortic insufficiency;4. Patients with no history of hypertension;5, we find cornary sinus flow is well in operation,and the heart arrests completely. Postoperative follow-up of the 1st year, the 3rd year, the 5th year, the 8th year, the 10 th year and 15 th year, according to the results of echocardiography, dividing the patients into group without aortic regurgitation,G1;the group of mild aortic insufficency,G2; the group of mild to moderate aortic insufficiency, G3;the group of moderate aortic insufficiency and more than moderate G4; at the same time to collect patient gender, age, preoperative and postoperative cardiothoracic ratio, aortic diameter, left ventricular diameter size, ejection fraction,shortening fraction and NYHA classification. To analyze the data of preoperative and postoperative patients using SPSS 21.0 statistical analysis software.Results:A total of 250 cases of the patients with rheumatic heart disease underwent mitral valve insufficiency with mild aortic regurgitation were included in this research. All the patients were successfully completed mitral valve replacement, rehabilitation and leaving hospital.No serious complications occurred during hospitalization. There were 229 patients(91.6%) completed the review and follow-up, 6 patients(2.4%) was incomplete follow-up with complicated with cerebrovascular accident after discharge or for other reasons, including 3 cases of death;In addition, there are 15 patients(6%) did not return to hospital to finish related review.The collection of the cases,there were 54 cases in 1st year,and completing postoperative follow-up of 50 cases(92.6%);there were 52 cases and completing postoperative follow-up of 48 cases(92.3%);the case in the 5th year was 47 cases, complete postoperative follow-up of 44 cases(93.6%); there were 33 cases in the 8th years and completed postoperative follow-up of 30 patients(90.9%), there were 33 cases and complete postoperative follow-up of 30 patients(90.9%);the where were 33 cases,andcompleted postoperative follow-upof 27 cases(87.1%).Patients also have varied degrees of heart function improved after surgery.After operation in the 1st year, 3rd year, 5th year, 8th year and 10 th years, 15 th years, the proportion of aortic insufficiency compared with preoperative is about 90%, 94%, 91%,90%, 86.7%, 85.2%.In the follow up of 1-8 year, there were 7 cases from mild aortic insufficiency to no insufficiency; There are 8 cases from mild aortic insufficiency to mild- moderate aortic insufficiency, and there are 8 cases from mild to moderate aortic insufficiency to moderate insufficiency or more.Conclusion:To masterstrictlytherapeutic indications of patients with rheumatic heart disease underwent mitral valve insufficiency with mild aortic regurgitation, its most of aortic insufficiency was without aggravation in a long period, so treatment may not need at the same time of operation.Some patients with mild aortic insufficiency after surgery may disappear in 8 year;And mild aortic insufficiency has little chance to become serve.